Action Points

Ischemic heart disease patients who had positive attitudes were more likely to exercise and were less likely to die from any cause at 5-year follow-up.

Note that positive affect was more common in patients who were male, had higher education, and were employed, and was associated with lower likelihood of diabetes and COPD.

Ischemic heart disease patients who had positive attitudes were more likely to exercise and were less likely to die from any cause at 5-year follow-up, researchers found.

High positive affect was associated with a significantly reduced risk of all-cause mortality (unadjusted hazard ratio 0.58, 95% CI 0.37-0.92) and a significant chance of exercising (unadjusted odds ratio 1.99, 95% CI 1.44-2.76) among 607 Danish ischemic heart disease patients, according to Susanne Pedersen, PhD, of Tilburg University in the Netherlands, and colleagues.

Additionally, patients who exercised were 50% less likely to die by the 5-year follow-up (HR 0.50, 95% CI 0.31-0.8, P=0.004), they wrote online in Circulation Cardiovascular Quality Outcomes.

"Interventions aimed at increasing both positive affect and exercise may have better results with respect to patients' prognosis and psychological well-being than interventions focusing on one of these factors alone," the authors said.

Patients with ischemic heart disease commonly present with depression, anxiety, and "other negative affective states," which have been tied with other major adverse cardiac events and death, despite advances in treatment of ischemic heart disease that have reduced mortality, they wrote.

The study measured whether positive affect was predictive of time to first cardiac-related hospitalization and all-cause mortality, and if exercise was tied to the relationship between affect, hospitalization, and mortality among heart disease outpatients.

Participants completed the HeartQoL questionnaire, an international cross-sectional survey of health-related quality of life.

Information on clinical history up to 10 years before baseline (January 1996 to November 2005) was collected from the National Patient Register. This information included diagnoses and hospital surgeries for a number of conditions including MI, angina, arrhythmias, cardiac arrest, percutaneous coronary intervention, coronary artery bypass graft, renal failure, diabetes, and chronic obstructive pulmonary disease (COPD).

Mean patient age was 65.5 and 75.5% of participants were men. Nearly half did not exercise regularly (46%), while the majority engaged in moderate regular exercise (54%).

Positive affect was more common in patients who were male (P=0.002), had higher education (P<0.001), and were employed (P=0.004), and was associated with lower likelihood of diabetes (P=0.039), and COPD (P<0.001). Patients with positive affect were also less likely to have a diuretic prescription (P=0.006) or use psychotropic medications (P≤0.001).

At the 5-year follow-up, 13.2% of patients had died by a mean 4.7 years. A significantly greater number of patients with low positive affect than high positive affect died at follow up, "with the cumulative hazard functions differing significantly between patients wit high versus low positive affect."

Associations between exercise and positive affect remained significant after adjustment (adjusted OR 1.48, 95% CI 1.03-2.13, P=0.036), as did associations between exercise and risks of dying among those with positive affect (adjusted HR 0.41, 95% CI 0.26-0.66, P<0.001).

Patients were also significantly less likely to be hospitalized with positive affect in an unadjusted analysis (HR 0.98, 95% CI 0.97-0.99, P=0.004). Also, patients who exercised were less likely to be hospitalized for cardiac diagnoses when compared with those who did exercise (OR 0.76, 95% CI 0.61-0.95). However, neither the association between positive affect and hospitalization, nor the relationship between exercise and hospitalization, was significant in the mediation model, the authors pointed out.

"The association between positive affect and exercise merits more attention as well because a paucity of studies has considered this relationship," the researchers noted.

One study limitation was that "because positive affect and exercise were both measured at baseline, the design of this study does not permit us to draw conclusions about the direction of causality," the authors said.

Additionally, the study participants were mainly European so the results may not have general application. Finally, the authors did not have information on the type of exercise or exercise intensity.